'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

GPs must reduce admissions to receive full funding under voluntary contract

GP practices that fully sign up to NHS England's new voluntary GP contract will see their funding decrease if they fail to reduce admissions.

NHS England board papers today reveal that there will be three levels of sign-up to the 10-15-year contracts, which will allow practices to hold on to their GMS contracts alongside the new contract if they so wish, but will also give the option of becoming fully integrated into a 'multispecialty community provider' - which will provide secondary care services as well.

There will also be a watered down contract for practices working in an alliance to provide certain services.

NHS England said the fully integrated model will include a 'gain/risk share' for acute activity, meaning that funding for the organisations will depend on reducing acute admissions.

The contract will also include a capitation element based on the size of its patient list, and a performance element to replace QOF - as already announced by then Prime Minister David Cameron - and the secondary care equivalent, CQUIN.

The GPC warned that there were risks to practices signing a local time-limited contract.

The board paper said: 'The fully integrated contract will be a new simpler hybrid of a standard NHS contract and a contract for primary medical services. It will set national and local service requirements and standards.

'It will last much longer than a normal NHS contract: 10 or 15 years. The contract sum comprises three parts: (i) a whole population budget for the range of services covered; (ii) a new performance element that replaces CQUIN and QOF; and (iii) a gain/risk share for acute activity.'

NHS England's definition of a multispecialty community provider (MCP)

NHS England's board paper says MCPs will 'combine the delivery of primary care and community based health and care services' including 'planning and budgets' while also incorporating 'a much wider range of services and specialists wherever that is the best thing to do'.

Key features of the 'fully integrated' MCP model include:

Holding a single whole population budget across the range of services it provides, based on the GP registered list - the MCP covers the sum of the registered lists of the participating practices, plus the specified unregistered population;

Built around ‘care hubs’ of integrated teams, each typically serving a community of around 30-50,000 people (but NHS England says that all the 14 MCP vanguards now serve a minimum population of around 100,000);

A place-based model of care which serves the whole population, not just an important subset such as people over the age of 65;

Operates at at the whole population level, aiming to 'bend the curve of future healthcare demand' by addressing 'the wider determinants of health and tackle inequalities';

Builds a 'coherent and effective local network of urgent care' for people with 'self-limiting conditions';

Provides 'a broader range of services in the community that are more joined-up between primary, community, social and acute care services, and between physical and mental health' for people 'with ongoing care needs';

Delivers an ‘extensive care’ service for 'small groups of patients with very high needs and costs'.

NHS England said these models could build from a GP federation or super-partnership, be entirely voluntary, and not mean having to give up the GMS contract.

The board paper said: 'It opens up the prospect of new options for how GPs and other clinicians could relate to the MCP, but will not compel an existing practice to leave the security of its GMS contract in perpetuity.'

Dr Brian Balmer, BMA GP Executive member, said: 'The BMA will be looking at these proposals in detail, but we remain concerned that there are number of risks to GP practices who might sign a local, time limited contract.

'We would prefer that NHS England moves ahead with an MCP that allows different forms of contractual arrangements, so that innovation and flexibility is encouraged, while retaining a registered list based service that has been one of the great strengths of general practice.'

NHS England also announced it would expand its 'vanguard' programme of support for developing MCPs as well as the trust-led Primary and Acute Care System.

The board paper said: 'To accelerate progress and support double running costs, a national New Care Models funding stream will contribute to supporting additional future MCPs and PACS. In 2017/18 we expect to

'This autumn NHS England and NHS Improvement will be inviting applications for national support for future MCPs, PACS and acute care collaborations, linked to the next phase of sustainability and transformation planning.'

2. Meanwhile we are ideally placed to handle everything from the sniffles to HIV plus boiler maintenance, diet advice for porkers, and a safe and well check on anyone who hasn't been in to pay their newspaper bill for a fortnight. Be Clear On Cancer drives hundreds of well towards us, NHS health checks stoke demand for statins in anyone just out of adolescence, and GANFYD garbage multiplies like e-Coli.

Anything has to be better than the present contract, but then I said that about PCTs and got an even more dysfunctional CCG.The devil is in the detail, and in the implementation. I must be an eternal optimist in that I continue to believe that things can be done so much better, but someone, sometime is actually going to listen and let GPs actually run things the way they should be run.

Deja vu! The stick is thicker than the carrot. For someone who hasn't ever signed up to Unplanned admissions DES and considered it a waste of precious clinical time, it's an opt out even before the programme has begun.

Just wait until the sustainability and transformation plans kick in. There will be no hospital beds to admit patients to! So that will reduce hospital admissions without us even trying. God knows how we are going to manage in the community.

Some HMOs in the states have managed to reduce hospital admissions. They are fully integrated organisations involving primary and secondary care. So traditional hospital doctors work across hospital and community settings. They basically provide full hospital at home including bloods, scans, x-rays etc. I presume this saves them money. I don't think there is any strong evidence of stopping exacerbations of chronic disease. Besides the longer we keep people alive the more chronic problems they develop and the greater cost to the government, not to mention increased social care costs.